Interventions at the macro and micro levels could help save women and men from fatal domestic violence.

I had the privilege of coauthoring with Albert Roberts what turned out to be his final contribution to social work literature. Our book, Death by Domestic Violence: Preventing the Murders and Murder-Suicides, integrates content from his lifelong research in the area of domestic violence. This work included Roberts’ crisis intervention model developed from his early years of domestic violence research and his more recently obtained set of personal narratives from battered women who killed their abusers.

As conceptualized by Roberts, crisis intervention takes place at both macro and micro levels and involves community, as well as individual, components. First, let’s look at the incidents of domestic homicide nationwide and macrolevel interventions.

The National Crisis in Domestic Homicide
Data from the Bureau of Justice Statistics tell us that in the United States, more than 1,000 women and more than 300 men are killed annually due to intimate partner violence. At one time, these numbers were roughly even. This was before women’s shelters and other services for female victims were introduced to provide an alternative avenue of escape. This fact—that domestic violence services are saving the lives of more men than women—is little noted. In any case, today, men clearly are more likely to kill their partners than women are to kill theirs.

The character of the homicide differs by gender as well. Men who kill women typically show a pattern of long-term battering and threatening behavior. Interviews with men convicted of partner homicide bear this out, as well as interviews with women who survived attempted murder (see David Adams’ Why Do They Kill? Men Who Murder Their Intimate Partners).

Women who kill the men in their lives, in contrast, are more often victims than victimizers. We learn this from Roberts’ interviews comparing a sample of 105 women who had been convicted of killing their partners and were serving prison time with an equal sample of battered women from the community. Roberts found that virtually all the women in prison had a history of being battered and receiving death threats. In contrast to the comparison group, the majority of the female prisoners had a history of sexual and substance abuse, had attempted suicide, and had access to the batterers’ guns.

Consider the personal narrative of Alicia, who in this excerpt from her story describes the buildup to murder: “Alcohol always triggered it. He was an alcoholic. If he didn’t use me as a punching bag, he would destroy personal property. I had bruises all over my body, black eyes, and choke marks. Sometimes I would fight back, and it would only make it worse.” Alicia also suffered a miscarriage as a result of falling down the stairs when her husband was chasing her to continue an assault. In her own words: “… he tried to kill me. I was late coming home from work, and he called me a liar, this, that, and the other thing. He was drunk and drugged out.”

Research confirms that during the time of pregnancy and shortly after giving birth, women are highly vulnerable to domestic violence. In fact, according to the Family Violence Prevention Fund, women are more likely to be victims of homicide at the hands of their partners during this time than to die of any other cause. Throughout the world, pregnancy is a period of high risk for both battering and homicide.

Risk factors that emerge from the research literature based on interviews with surviving family members are the female partner’s attempts to break off the relationship, the abuser’s lack of employment compounded by a lack of education, no police arrest for a prior assault, and having a child in the home who is not the partner’s biological child. Other factors that can help predict homicide are an abuser’s use of illicit drugs and access to firearms. The psychological profile of a killer-batterer is of a man who was chronically abused by his father as a child and who is extremely possessive of his partner whom he controls economically and through threats of violence.

Crisis Intervention at the Societal Level
Domestic violence research emphasizes the importance of primary prevention. Instead of focusing on healing individuals who have been injured, primary prevention efforts take place at the societal level and are proactive rather than reactive. Since domestic homicide, like domestic violence, is a public health problem, a pragmatic or harm reduction model is essential to its prevention. To reduce violence, emphasis is placed on identifying policies and programs aimed at the whole society. A logical place for violence prevention programming is in public schools.

One in five teenage girls experiences such violence, according to recent school surveys. From a harm-reduction perspective, the need is for educational programming, starting at the junior high or middle school levels, to help youths learn the qualities of a healthy relationship and an awareness of traits such as jealousy and possessiveness that may be warning signs of pending violence.

Violence prevention programming has begun to make headway in schools across the United States in the form of projects such as Mentors in Violence Prevention, which focuses on gender violence prevention through peer group training. Parent education is also stressed. School leaders and athletes are taught to be aware of media sex stereotypes and how to defuse potentially violent situations.

From the standpoint of the legal system, a practical intervention involves tightening gun control laws and restricting the access to firearms by convicted batterers. Since the overwhelming majority of murder-suicides involve a firearm, as do a majority of domestic homicides, stronger state laws are required to reinforce federal laws requiring that such weapons be removed from the homes of domestic abusers. States that carefully limit access to guns by individuals under a restraining order have significantly lower rates of intimate partner homicide than those without these laws.

Crisis Intervention at the Agency Level
Secondary prevention (also called screening) refers to measures that detect problems in need of treatment. Social workers and victim assistance professionals must determine the level of danger in the familial environment before it escalates. Harm reduction here is aimed at high-risk populations such as battered women who go to an emergency department for treatment and men who have alcohol and other drug problems (especially cocaine and methamphetamine) that are associated with violence. Screening for violence-related problems should be routine in substance abuse work. Families that come to the attention of the Department of Human Services for child abuse fall under this category and should be screened for wife-partner violence as well.

Persons at high risk of injury are given a checklist of questions to determine their degree of risk. Asking such questions has an educational function as well; these questions are designed to alert the individual to the fact that she (or sometimes he) may be in considerable danger. Individuals are asked about such matters as heavy drinking and illicit drug use and the availability of weapons in the house.

Despite the obvious dangers of having a gun in the home, Karen Slovak, PhD, an assistant professor of social work at Ohio University’s Zanesville campus, discovered in her recent survey of mental health social workers that they rarely asked about firearms ownership when assessing clients for risk factors for suicide, homicide, etc. She recommends specialized training for mental health professionals on the hazards of gun ownership.

Crisis Intervention at the Personal Level
At this level, which is the treatment level, prevention efforts consist of interventions to help people alter their undesirable and destructive behavior and/or risks of harm. Relevant to domestic homicide, violent offenders may be placed in batterers’ education programs under the auspices of the criminal justice system, or they may be sentenced to jail and prison terms for the protection of society. From the survivors’ standpoint, nothing is more pathological than living on the edge of life-threatening violence, and safety plans must be adopted for their protection.

Because of imminent threats and danger, it is important to respond quickly to battered women and provide immediate and systematic intervention. To meet this need, Roberts developed a Seven-Stage Crisis Intervention Model for battered women to assess their loss-of-life risk. Stage 1 provides an evaluation of the psychological harm and physical injury to the victim, gauges the duration and severity of violent events, and calculates the likelihood of the victim’s escaping and ending the battering cycle. The assessor can use an empirically validated danger assessment instrument such as that developed by Jacquelyn C. Campbell, PhD, RN, FAAN, and available online at www.musc.edu/vawprevention/research/instrument.shtml. This instrument is useful for alerting potential victims to patterns of behavior that are associated with escalating violence.

Additional stages delineated in the crisis intervention model are establishing rapport and communication, identifying the major problems, dealing with feelings and providing support, exploring possible alternatives, formulating an action plan, and follow-up measures.

The crisis worker must help the client look at both the short-term and long-range impacts of planning intervention. Such a plan is designed to ensure a woman’s safety, even if she chooses to remain in a threatening situation. The safety plan involves memorizing relevant phone numbers of domestic violence and legal services, a coded statement that can be conveyed to trusted relatives in telephone calls or e-mail messages to signal that help is needed, secretly storing duplicates of personal records and resources that the woman and her children may use later in the event of emergency relocation, and thought given to a specific plan of a safe place to which one ultimately may escape.

Since substance abuse by either party enhances the risk that the violence will be deadly, counselors are advised to explore options for discouraging heavy drinking and drug use. Getting rid of lethal weapons is a priority as well in conjunction with severe depression and suicidal ideation among the abusers.

By knowing the facts about the dynamics of life-threatening situations that may end in the death of one or both partners, healthcare practitioners and social workers can be cognizant of the indicators that can serve as a basis for preventive intervention crisis and, in collaboration with the potential victim of domestic homicide, the development of a safety plan at the earliest possible moment. But therapy for the victim alone may mean that one woman will achieve independence from her abuser for a time, but she still may not be safe. He, the former batterer, may still have visitation rights to the children following divorce. Some will use this power to intimidate and threaten their former wives. Still others will enter into new abusive relationships.

In the effort to save lives, therefore, batterer intervention is a must. Since research tells us that most men who commit partner homicide have a pattern of escalating violence and use verbal threats, prevention at the earliest possible indication of violence is apt to have far-reaching impact. Court-certified programming should allow for a variety of approaches tailored to individual need and after-screening for readiness to change. Approaches may include anger management, substance abuse and mental health treatments, individual therapy focused on early childhood victimization issues, and work on feeling empathy for others. An innovative idea from New Zealand is to drastically increase spending on support services for battering men and provide for a drop-in center for men when they feel themselves getting out of control.

Efforts to prevent domestic homicide must be comprehensive, involving work with potential batterers and victims, and be geared toward societal as well as individual levels. For specific guidelines, see the Harm Reduction Prevention Model for Social Workers in the sidebar below.

— Katherine van Wormer, MSSW, PhD, is a professor of social work at the University of Northern Iowa and coauthor of Death By Domestic Violence: Preventing the Murders and Murder-Suicides.

Harm Reduction Prevention Model for Social WorkersAt the Biological Level
• Screen all clients for substance abuse and provide treatment as needed.

• Screen all clients for mental disorders and provide appropriate treatment for both substance and mental disorders simultaneously; refer for medication where appropriate.

At the Psychological Level
• Use motivational enhancement strategies to help batterer’s change and victims to adopt a safety plan.

• Screen for depression and suicidal ideation.

• Take a cognitive approach directed at irrational thinking associated with violence.

• Provide anger management and assertiveness training.

• Offer individual counseling for early childhood victimization and trauma from other causes.

• Help clients refrain from blaming victims—teach empathy.

• Help battered women from a stages-of-change model to protect themselves and their children.

At the Societal Level
• Establish school antiviolence programming with an emphasis on male mentoring.

• Develop school programs to teach principles of healthy relationships.

• Endorse media campaigns against intimate partner violence.

• During medical checkups, screen for firearms in the home, and emphasize the dangers in having firearms available, especially in households characterized by chronic conflict and/or heavy substance use.